This July, the biannual International AIDS Conference (IAC) hosted by the International AIDS Society, brought together a virtual assortment of HIV and SRHR activists, researchers, and other experts in an innovative effort to continue the exchange of ideas in global HIV research, policy, and more. One particular session that stood out to me was called “An Overlooked Epidemic: Mental Health and HIV” sponsored by the International Community of Women Living with HIV. In this session, it became clear to me that mental health and HIV services are oftentimes not thought about, nor mentioned, in relation to each other. As a young person majoring in psychology and an intern working in SRHR at the time, I asked myself, “Why haven’t I made this connection before?” Our mental and sexual and reproductive health (SRH) are inherently linked, and failure to acknowledge their relationship is a disservice to those struggling with their mental health and anyone in need of SRH services - aka, everyone! But how does the failure to integrate these services particularly affect the lives of people living with HIV (PLHIV) - particularly young people living with HIV?
Worldwide, major depressive disorder and general anxiety disorder compared are more common among PLHIV than the general population. In the United States; approximately 36% of PLHIV in the US experience major depressive disorder while 15% have general anxiety disorder, compared to a respective 6.1% and 2.1% for the general population in the US. The higher rates of mental illness among PLHIV can be linked to structural factors, such as poverty and unstable housing; environmental factors, including community disinvestment leading to a lack of access to high-quality health services; biological health issues; and stigma and criminalization around certain populations (e.g., Black Indigenous, and People of Color (BIPOC), sex workers, trans folx). Unsurprisingly, these interrelated systems of oppression also mainly affect low-income communities and communities of color within the systems of structural racism and classism.
If an adult living with HIV is at an increased risk of mental health issues, what about a young person living with HIV? During our youth and adolescence, the physical, mental, and social changes that we, young people, experience have been proven to increase our vulnerability to mental illness. It is no surprise that young people living with HIV also experience higher rates of depression and anxiety disorders compared to adolescents who do not have HIV across country contexts and can show increased levels of attempted suicide and self-harm. Essentially, we know that stigma, discrimination, and oppression, increase the chances for PLHIV of all ages to develop mental illnesses after their diagnosis.
At the IAC session, Lillian Mworeko, Executive Director of the International Community of Women living with HIV in Eastern Africa stated that some people, including young people, living with mental illnesses tend to engage in sexual behavior that may increase their susceptibility to HIV, other STIs, and unintended pregnancies. Such behavior may include condomless sex, sex with multiple partners, and other activities. But let’s be clear, this should not be taken as an opportunity to stigmatize or shame young people or people living with mental illness for their sexual activity. Mental illness can impact so many aspects of our daily life. For example, folx living with depression, or anxiety may face challenges to their productivity, concentration, physical health, work-life balance, personal relationships, and more. It makes sense that these same mental illnesses would also impact the ways we engage with sex and our ability to acquire and engage in HIV prevention care or treatment.
For PLHIV, facing the discrimination attached to a positive status, violence, lack of social support, change of routine, changes in health and physical appearance, and more - are all factors that can have detrimental effects on one’s mental health. Research has also shown that PLHIV are more susceptible to violence prior to and after their diagnosis. This can include, intimate partner violence, sexual abuse, and other forms of violence. All of these factors and experiences highlight the need for mental health services for PLHIV; however, many PLHIV, particularly young people, are discouraged from seeking such care. As mentioned by a youth activist in the IAC session (whose name was not disclosed), the stigmatization of needing mental health services has discouraged young people from being candid about their mental health needs and seeking support.
The data are clear- mental health services must be integrated into youth-friendly, accessible SRHR services, particularly during the COVID-19 pandemic. Research has already shown the effects the pandemic has had on mental health, particularly for BIPOC who already faced disparities of access to mental health services pre-COVID-19. For young people and adults living with HIV COVID-19 could be an added weight to their mental health and quality of life. During this time and especially during periods of lockdowns, PLHIV may have difficulty accessing and taking their medication due to their location or living situation. Some may be residing in unsafe or abusive households or facing other life stressors such as joblessness, food insecurity, loss of a physical community, among others. It is clear that for people with mental illness, PLHIV, and young people, this integration of mental health and SRH services, including HIV services, cannot wait.